Abstract Background In dengue-endemic regions, early presentations are often mislabeled as mild viral illness or dehydration, delaying recognition of severe disease. These diagnostic blind spots disproportionately impact Latina and Hispanic patients when local epidemiology is underweighted. Severe dengue requires high clinical suspicion to prevent rapid progression to shock, ARDS, and multiorgan failure. Case Presentation A previously healthy young Latina presented twice within 24 hours for malaise, nausea, and generalized weakness. On re-evaluation, she was hypotensive and tachycardic with marked dryness and respiratory distress. Laboratory evaluation revealed leukopenia, anemia, and thrombocytopenia. Arterial blood gas demonstrated acidemia with hypoxemia. She was admitted to the medical ICU with suspected severe dengue and septic shock. CT abdomen revealed periportal and gallbladder wall edema, renal hypoperfusion, pancolitis, and mild peritonitis—radiologic indicators of systemic capillary leak. Despite cautious fluid titration, vasopressors, and antimicrobial coverage, she progressed to diffuse pulmonary crackles, petechiae, and ARDS. Serology confirmed dengue virus infection. Discussion Early clinical subtlety should never obscure the potential for catastrophic arboviral sepsis. In dengue-endemic areas, concurrent cytopenias, metabolic acidosis with hypoxemia, and imaging features of third spacing demand urgent consideration of severe dengue. Over-resuscitation can worsen plasma leakage and pulmonary edema; thus, vasopressor-driven hemodynamic support and early critical-care activation are essential. Diagnostic delay may be compounded by implicit bias and limited integration of endemic disease patterns into initial triage reasoning. Conclusion Recognizing the hallmark triad of cytopenias, metabolic acidosis with hypoxemia, and radiologic third spacing can narrow diagnostic blind spots and prevent progression to ARDS and multiorgan failure. Integrating endemic epidemiology into clinical reasoning is essential not only for timely, evidence-based care—but also for advancing health equity. This abstract is funded by: None
Salgado et al. (2026) studied this question.